Role of heparin during endovascular therapy for acute ischemic stroke

Naureen Farook, Diogo Haussen, Samir Sur, Brian Snelling, Zachary Gersey, Dileep R Yavagal, Eric Peterson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objectives Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS). Patients and methods We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale). Results Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p = 0.01), Coumadin (0% vs. 11%, p = 0.04), and NIHSS (15.6 ± 5.0 vs. 18.1 ± 4.6, p = 0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p = 0.35). Patients who received heparin had significantly lower rates of hemorrhage (p = 0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p <0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p = 0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p <0.01) independently associated with mRS 0-2 at 90 days. Conclusion The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation.

Original languageEnglish (US)
Pages (from-to)64-67
Number of pages4
JournalClinical Neurology and Neurosurgery
Volume145
DOIs
StatePublished - Jun 1 2016

Keywords

  • Acute ischemic stroke
  • Endovascular therapy
  • Hemorrhage
  • Heparin
  • Intraarterial therapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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